Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials
Authors' conclusion
This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes.
Study context
- Population
- Adults with T2D in RCTs with follow-up ≥24 weeks; Ovid Medline, Embase, Cochrane Central up to 14 October 2022
- Participants
- 471,038 adults816 trials
- Comparison
- Drug classes for T2D vs standard treatments
- Outcome
- All cause death
Methodological detailsGRADE certainty assessment
- GRADE certainty assessment
Pooled result
As reported in the abstract
Each group vs standard treatmentsOdds ratio (95% CI)
SGLT-2 inhibitorshigh certainty
0.88(0.83–0.94)
GLP-1 receptor agonistshigh certainty
0.88(0.82–0.93)
Non-steroidal mineralocorticoid receptor antagonistsmoderate certainty; probably reduce mortality
0.89(0.79–1.00)
Further pooled results
| Outcome | MD (kg) |
|---|---|
| Body weightTirzepatide vs Standard treatments · moderate certainty; largest reduction | −8.57 |
| Body weightBasal insulin vs Standard treatments · moderate certainty | 2.15 |
| Body weightThiazolidinediones vs Standard treatments · moderate certainty | 2.81 |
CV death, non-fatal MI, HF hospitalisation, end stage kidney disease, non-fatal stroke
- SGLT-2 inhibitors and GLP-1 receptor agonists reduce CV death, non-fatal MI, HF hospitalisation and end stage kidney disease
- Finerenone probably reduces HF hospitalisation and end stage kidney disease, and possibly CV death
- Only GLP-1 receptor agonists reduce non-fatal stroke
- SGLT-2 inhibitors superior to other drugs in reducing end stage kidney disease
Quality of life
- GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life
Safety
- Harms largely drug class specific: genital infections with SGLT-2 inhibitors, severe GI adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to hospital admission with finerenone
Original publication
Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ. Published 6 April 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →